HomeMy WebLinkAboutBLD1979-00490 BUILDING PERMIT APPLICATION 14. 7146
Jefferson County Building Department• County Courthouse •Port Townsend, Wash.98368 • 385-1310
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I. LOCATION: geographic name S W SIDE OF ROAD FEET
N E
S W FROM INTERSECTION OF l ROAD AND ROAD
other specific location or landmark:��Z.. li In Y Yf;.'u i- C:1 Lac."-TNA ,
LEGAL DESCRIPTION:
• < Lot Block Subdivision
.
• Tax Number Y.Section Section Township Range
II. TYPE AND COST OF BUILDING -
- ' TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
\
__T CI New building LgSingle Family ❑New County Resident
��Addition El Multi-Family Is this structure to serve the residential
,,❑``Alteration number of units or commercial needs of those employed
`� ❑ Repair,replacement El Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
number of units Indian Island Facilities?
c i,c El Wrecking
El Mobile Home
El Moving (relocation)
El Other—Specify ❑YES V NO
El Foundation only
USE
OWNERSHIP
❑Full-time Residence
Private (individual,corporation,
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: I-3, ❑Second Home: Future conversion to
permanent residence
COST (Omit cents) Nonresidential— Describe in detail proposed use of buildings,e.g.,food
• Cost of improvement $ processing plant,machine shop,laundry building at hospital,elementary
To be installed but not included school,secondary school,college,parochial school,parking garage for
in the above cost department store,rental office building,office building at industrial plant.
a. Electrical If use of existing building is being changed,enter proposed use.
b. Plumbing Artaikicrn
40 c ci4,c hcJrna -
c. Heating,air conditioning
d. Other (elevator,etc.)
. • TOTAL COST OF IMPROVEMENT $ I /0,00
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
❑Masonry (wall bearing) ElPublic or Private •Number of Stories t
•Total square feet of floor area,
'Wood Frame El Indivi u (septic tank,etc.) all floors,based on exterior
- , El Structural steel kaj dimensions 17,,Z`,
�-, - TYPE OF WATER SUPPLY
--_ ❑Reinforced concrete •Total land area,sq.ft.
El Public or private company
❑Other-Specify NUMBER OF OFF-STREET
XIndividual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
(?—' ❑Oil RESIDENTIAL BUILDINGS ONLY
,S Electricity — Number of bedrooms
❑Coal TYPE OF MECHANICAL •
Other—Specify NO C
Number of Full
bathrooms
Partial
IV. IDENTIFICATION -
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
t„ •. c,-- 1. 6-t���� cr \ -. `�7,s E . /hcarrp►,o_ �,nP_, $: a5 3�5- 13`i�.
Owner
2. T-f-) shou ( ►ace 4 6(-h t� To Q 's �r,d --- -acc,-1fa
Contractor State License No.
r
3.
Architect
—
The owner of this building and the undersigned agree to conform to all applicable laws.
7 Signa r iy,49;L_ Address plicatio date
_-) of ppli 475-- L . /294 1(i J5tciAo , xii)✓4I d —
PLANNING AREA E DISTRIC CHOOL DISTRICT WATER DISTRICT
APPROVED BY
OLYMPIC HEALTH DISTRICT: �---- ( \,...1
APPROVED BY: PERMIT FEE ISSUE DATE PERMIT NUMBER
Wig -- `y i__ ,(i.-7r oo
BU,I-t DING OFFICIAL
II The Printery—Port Townsend
N° 226
.. le 1 on County Building Permit
\\. teve Bergstrom—
Owner �_ — - — —
_ _ ___ East----Marr_oAs_t ne- --
-
__ Nordland, WA 98358
Contractor Ilan___Shaul_._.--_.-_____.______.-__.-.
----- - - - 1204 lath .. - -- -- ---
-....... Po 't---Tawnse-►a�-,--WA--- 8-
State License No. _--- ------ ---
Legal Description and Address \ '\_ '________ _.—
Fi re Itunmber....4Z_-5----East-------
Marrowstone Drive, —_
.
Marrows tone.-__Is-la.nd _---------
•
TYPE OF IMPROVEMENT: 1—New Building 2j(-Addition
3—Alteration 4—Repair/Replacement 67Wrecking
5--Moving (relocation) 7—Foundation only
Residential 0 Single 0 No. of Units --
Non-Residential 0 Specify _------------------
INSPECTIONS:
II , ,
rt' . T.1 d tr 14 6#0 . .T . . �D*
STATE E—EC ATE
r
5 1r' , �.
K A
TRICAL DATE
C, Camp b e-l.1 9/.14/_7_.9 _-
ISSUING OFFICER DATE
VALID FOR ONE YEAR ONLY
f' _